Evidence-based Intervention Programs Research Articles

Multi-tiered Systems of Support for School-Based Mental Health: A Systematic Review of Depression Interventions

Despite the prevalence and negative consequences of depressive disorders among youth, as well as the need for schools to adopt and implement a continuum of mental health services to address depressive disorders, school mental health providers receive very limited guidance in the selection and application of appropriate evidence-based depression prevention and intervention programs for use within a school-based multi-tiered system of support (MTSS). With the goal of supporting school-based mental health providers in the delivery of evidence-based practices targeting depressive symptoms among youth within a MTSS framework, the following study sought to conduct a critical review of the existing school-based prevention and intervention programming for depressive disorders for youth. A systematic, four-stage review was performed from which 119 studies examining 57 unique programs were identified. A review of the studies, including presentation of various participant (e.g., age, grade, ethnicity), study (e.g., control group, randomization), and program (e.g., primary focus, findings, MTSS tier) characteristics, is included. Implementation considerations review and future directions for research are discussed.

A trend analysis of sexual health behaviours of a national sample of Canadian adolescents using HBSC data from 2002–2014

Regular monitoring of trends in sexual health behaviours of adolescents is required to guide evidence-based intervention programs and health policies. The purpose of this study was to examine national trends in sexual behaviours of Canadian adolescents from 2002 to 2014. Method: A secondary analysis of data was conducted using the Canadian Health Behaviour in School-Aged Children (HBSC) survey of Grade 9 and 10 students over four survey cycles. Sexual behaviours of interest were ever having sexual intercourse, early onset of sexual intercourse, and oral contraceptive, condom, and dual method use at last intercourse. Disaggregated by gender and survey cycle, data were analyzed using cross-tab analyses and aged-adjusted logistic regressions. From 2002 to 2014, boys had decreasing trends in early onset of sexual intercourse [AOR = 0.55, 95% CI = (0.36–0.85), p = 0.008], and increasing trends in oral contraceptive use [AOR = 1.94, 95% CI = (1.24–3.04), p = 0.004]. During this time, girls had decreasing trends in condom use [AOR = 0.64, 95% CI = (0.41–1.00), p = 0.052], but increasing trends in oral contraceptive use [girls: AOR = 1.47, 95% CI = (0.98–2.19), p = 0.061] approaching statistical significance. No significant trends were noted in ever having sexual intercourse and dual method use for both genders. In sum, boys showed improvements in sexual behaviours over time. The inverse trends of condom use and oral contraceptive use suggested girls’ increasing reliance on oral contraceptive pills instead of condoms. Health services interventions and policies should consider implementing new strategies that better promote dual method use.

Clinical Practice Guidelines on Assessment and Management of Substance Abuse Disorder in Children and Adolescents.

Today's youth are tomorrow's future and hence it is very important to formulate the clinical practice guidelines for substance abuse disorder in children and adolescents. The previous guidelines were published in 2008, so it was of paramount importance to update the scientific information to guide management in recent times. According to the Census of India, 2011, adolescents (10–19 years) constitute one-fifth (20.91%) of the Indian population. The first nation-wide survey on children (5–18 years) conducted under the auspices of the National Commission for Protection of Child Rights (2013) at 135 sites across 27 states and 2 union Territories provides us with significant insights as to the magnitude and pattern of drug menace in this age group. Most children had used any one or more of the substances in their lifetimes with tobacco and alcohol leading the charts followed by cannabis, inhalant, opioids, sedatives, and heroin/smack; and there is progression from licit to illicit substances. The mean age at onset was 12.3 years with increasing age associated with increased use of illicit drugs. The type of substance preference varies in different geographical regions. Out-of-school and street children have an earlier onset and more dysfunction and almost half of them are working in unskilled jobs. It is to be noted that among these more than two-third had never sought treatment. The presentation of substance use problem differs in adults and adolescents as shown in Table 1. It is quite reasonable to say that adolescents will have much better prognosis if evidence-based treatment programs are designed keeping in mind these very fundamental differences and needs in mind. Table 1 Clinically significant differentiating characteristics of adolescent substance abusers from adult substance abusers

BehavioR: a digital platform for prevention and management of behavioural addictions.

Behavioural addictions have been identified as an emerging public health problem. The unprecedented pace of the digital revolution, resulting in an ever-increasing use of internet-based technologies, provides the opportunity to create a unique resource to assist in offering public health interventions in the World Health Organization South-East Asia Region. The ability to deliver evidence-based treatment and preventive programmes that can be accessed by mobile phones, for example, increases access to a wide range of populations, including hidden or hard-to-reach populations. BehavioR (the Behavioral addictions Resource hub) has been established with the aim of offering a one-stop resource centre for behavioural addictions. The expected end-users of this digital platform include patients, caregivers, the general public, health-care providers, academics, researchers and policy-makers. The platform can be used to offer digital health interventions to patients; strengthen the capacity of health-care providers for early detection of, screening for, intervention in and management of behavioural addictions; and serve as an online repository for reliable information on behavioural addictions for the general public.

Psychosocial Interventions Targeting Social Functioning in Adults on the Autism Spectrum: a Literature Review.

There is a perceived shortage of evidence-based treatment programs for adults on the autism spectrum. This article reviews the recent research literature on psychosocial/behavioral interventions targeting social functioning in autistic adults without intellectual disability. We identified only 41 peer-reviewed studies published from 1980 to 2017 that tested intervention programs focused on one or more of the behavioral components of social functioning (i.e., social motivation, social anxiety, social cognition, and social skills) in more than one adult with autism spectrum disorder (ASD). The studies demonstrated substantial variability in treatment objectives, intervention procedures, assessment methods, and methodologic quality. The results indicate a strong need for additional research to develop and rigorously test interventions for autistic adults that target the many behavioral components of social functioning and that include procedures to promote generalization of knowledge and skills to community settings.

Teachers' ratings of social skills and problem behaviors as concurrent predictors of students' bullying behavior

This study analyzed teacher ratings from the national standardization sample of the Social Skills Improvement System (SSIS) to examine the role of elementary and secondary students' social skills, problem behavior, and academic competence as they relate to bullying behavior. Regression analyses indicated slightly different concurrent predictors of bullying behavior for elementary (N = 544) and secondary (N = 200) students. Specifically, low levels of empathy skills and concurrent high levels of externalizing behaviors were relatively strong correlates with bullying behavior of both elementary and secondary school children. For secondary students, assertion skills exhibited at high frequency levels were also a significant predictor of bullying behavior. The resulting predictive models featured social behaviors that educators and other professionals can successfully improve with existing evidence-based intervention programs. A discussion of study limitations and future research concludes the report.

Applied Behavior Analysis, Students With Autism, and the Requirement to Provide a Free Appropriate Public Education

The prevalence of autism has been steadily rising over the previous decades. The diverse ways in which the disorder manifests in students and the free and appropriate public education (FAPE) mandate of the Individuals With Disabilities Education Act (IDEA) requires that a student’s individualized education program (IEP) team tailor interventions to meet the unique educational needs of that student. Deciding on the most appropriate evidence-based intervention programs for students with autism can be complex. In fact, a frequent source of litigation is when families and school personnel disagree on the particular programming to be provided to students with autism. Often this litigation involves disagreement over the extent to which services should be based on the principles of applied behavior analysis (ABA). The purpose of this article is to review select case law to analyze how courts have ruled on whether schools must provide ABA services to meet FAPE requirement when families request those services, and to extrapolate implications for practice, including guidance to families and school personnel on how to work collaboratively to resolve conflicts surrounding ABA services.

Does response to the STEPPS program differ by sex, age, or race in offenders with borderline personality disorder?

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is an evidence-based group treatment program for ambulatory patients with borderline personality disorder (BPD). The program was introduced to the Iowa correctional system in 2005, and groups have been ongoing ever since. In this analysis, we examine whether response to the STEPPS program differs based on sex, age (<40/≥40 years), or race/ethnicity (minority/non-minority) using data collected in Iowa prisons and in community corrections. Subjects were recruited and assessed by correctional staff. Offenders with BPD were offered the opportunity to participate in the STEPPS program. The presence of BPD was assessed using a module from the Structured Interview for DSM-IV Personality. Efficacy assessments included the Borderline Evaluation of Severity Over Time Scale, the Beck Depression Inventory, and the Positive and Negative Affectivity Scale. The Client Satisfaction Questionnaire-8 assessed program satisfaction. Data on 77 offenders were analyzed. All participated in the STEPPS program and 53% completed all 20 weeks. The analysis showed that there were no significant differences in response to STEPPS in terms of sex, age, or race/ethnicity on any of the three efficacy measures. Women expressed greater satisfaction than men, but there were no differences with regard to age or race/ethnicity. The implications of the findings are discussed.

Adolescents’ perceptions of school climate: Exploring its protective role in times of economic recession

The aim of the study is to explore the way Greek junior high school students perceive school climate as a protective factor against the adversities due to the ongoing economic recession. The randomly selected sample consisted of 746 students from junior high schools (Gymnasia) in the broader area of Athens. The California School Climate Survey (2009), the Questionnaire of Subjective Well-Being/Youth Form (Grob et al., 1991) and the Economic Crisis Difficulties Questionnaire ( LSP, 2011 ) were used for data collection. The findings indicated the existence of statistically significant relations between the effects of economic recession, subjective well-being and school climate. School climate moderated the interaction between economic recession and students’ subjective well-being. Results provide a better understanding of adolescents’ needs during unsettling times contributing to the development of effective evidence-based intervention programs in school communities.

Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study.

To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence-based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence-based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation. A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis. The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient- and provider-related challenges to the implementation were mentioned. The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.

Feasibility study of the SWITCH implementation process for enhancing school wellness

BackgroundThere is a need to identify strategies that enhance the implementation of evidence-based school wellness intervention programs in real-world settings. The present study evaluates the feasibility of empowering school wellness leaders to deliver an evidence-based, childhood obesity-prevention program called Switch ™. We specifically evaluated the feasibility of a new implementation framework, based on the robust Healthy Youth Places framework, to increase capacity of school leaders to lead school wellness programming.MethodsThe SWITCH (School Wellness Integration Targeting Child Health) implementation process was evaluated in a convenience sample of eight Iowa elementary schools. Teams of three leaders from each school attended an in-person school wellness conference followed by five online webinar sessions delivered by two SWITCH team members. The capacity-building and quality improvement process was designed to empower schools to lead wellness change using methods and concepts from the original 16-week Switch ™ program. School wellness leaders completed checklists on two occasions to assess overall school-level implementation as well as setting-level changes in physical education, classrooms, and the lunchroom. Student acceptability of SWITCH was evaluated by the degree of behavior tracking using an online SWITCH Tracker system that promoted self-monitoring. School acceptability and practicality were assessed through an exit survey completed by school leaders.ResultsAll school staff reported satisfaction with the SWITCH implementation process. Reports of school- and setting-level implementation were relatively high (2.0 to 2.8 on a 3-point scale) but student engagement, based on use of the online tracking system, varied greatly over time and across schools. Three high implementation schools had average tracking rates exceeding 70% (range: 72–90%) while three low implementation schools had rates lower than 30% (range = 0–23%).ConclusionsThis feasibility study supports the utility of the new implementation framework for promoting school and student engagement with SWITCH. Further testing regarding effectiveness and scale-up of this evidence-based school wellness intervention program is warranted.

Economic stress and well-being: Does population health context matter?

The purpose of this study was to investigate the role of county-level population health determinants in predicting individual employee reactions to economic stress. Using multilevel modeling and a population health perspective, we tested a model linking nationally representative individual-level data (N = 100,968) on exposure to economic stressors and county-level population health determinants (N = 3,026) to responses on a composite measure of individual well-being that included the facets of purpose, community, physical, and social well-being, as well as life satisfaction. Results indicate that higher income- and employment-related economic stress were significantly related to poorer well-being. Additionally, living in a county with more positive population health determinants was significantly predictive of individual well-being. Finally, the Level-1 relationship between income-related stress and well-being was significantly attenuated for individuals living in counties with more positive population health determinants. In contrast, employment-related stress had a stronger negative relationship with well-being for individuals who lived in counties with more positive population health determinants. We discuss these findings in light of conservation of resources and relative deprivation theories, as well as how they may extend the scientific foundation for evidence-based social policy and evidence-based intervention programs aimed at lessening the effects of economic stress on individual well-being. (PsycINFO Database Record

Suicidal ideation and behaviors within the school context: Perceived teacher, peer and parental support

School-related factors have been found to be associated with adolescents’ suicidal ideation and behaviors, including teacher and peer support. Research has tended to ignore the nested nature of school-related data, which may be critical in this context. The current study implemented a multi-level approach on data from the 2013–14 Health Behaviors in School-aged Children (HBSC-WHO) Israeli survey among high school children (N = 4241; 56% female). Participants completed measures of teacher-, peer-, and parental-support (coded reversely from 1 = high to 5 = low), and suicidal ideation and behaviors in the last 12 months. Hierarchical Linear Modeling (HLM), controlling for gender and age, revealed that classroom-level teachers’ support was significantly related to students’ suicidal ideation and behaviors (OR = 1.71, 95% CI = 1.20–2.44; OR = 1.39, 95% CI = 1.04–1.86; respectively), whereas parental (OR = 1.56, 95% CI = 1.40–1.75; OR = 1.41, 95% CI = 1.30–1.55; respectively) and peer support (OR = 1.21, 95% CI = 1.12–1.31; OR = 1.11, 95% CI = 1.02–1.21; respectively) were significant at the individual-level. The school environment can play a significant role in reducing risk for suicidal ideation and behaviors. Findings can inform future research and practice in planning and implementing evidence-based intervention programs within schools.

Impact of early intervention for youth with problematic sexual behaviors and their caregivers

ABSTRACTTargeting broad implementation of early intervention services has a high potential for impact given the prevalence of child sexual abuse committed by youth and the low recidivism rate following effective interventions. This multisite quasi-experimental study examined the outcomes for 320 youth ages 10–14 years and their caregivers who participated in community-based problematic sexual behavior – cognitive behavior therapy (PSB-CBT). Significant reductions in PSB with a large effect size (e.g. t(126) = 11.69, p < .001, d = 2.08) were found. No site differences were found, despite racial and regional diversity. Nonsexual behaviour problems, emotional problems, and trauma symptoms also significantly improved. Positive outcomes extended to caregivers. Recommended next steps include rigorous strategies for examining the impact of widespread implementation of evidence-based early intervention programmes on the prevention of sexual abuse, complemented with thoughtful efforts to develop and implement policies and procedures that improve the safety and well-being of all children in the community.

The effectiveness of Video-feedback Intervention to promote Positive Parenting for Foster Care (VIPP-FC): study protocol for a randomized controlled trial

BackgroundFoster children are at higher risk of the development of behavior and emotional problems, which can contribute to the development of insecure attachment bonds with their foster parents and (subsequently) to placement breakdown. Sensitive parenting might minimize the adverse effects of the behavior and emotional problems. Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline in Foster Care (VIPP-FC) is an adaptation of the evidence-based Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) and aims at increasing sensitive parenting and the use of sensitive discipline strategies of foster parents. The current study is the first to examine the effectiveness of VIPP-FC.MethodsA randomized controlled trial is used with 60 foster parent-child dyads (intervention group n = 30, control group n = 30). The primary outcomes are parental sensitivity, parental disciplining, and parental attitudes towards parenting. Data about attachment (in)security, behavioral and emotional problems, neurobiological parameters, and possible confounders is additionally collected.DiscussionExamining the effectiveness of VIPP-FC contributes to the knowledge of evidence-based prevention and intervention programs needed in foster care practice.Trial registrationNTR3899.

Effectiveness of an Assertive Community Treatment program for people with severe schizophrenia in mainland China - a 12-month randomized controlled trial.

Assertive Community Treatment (ACT) is an evidence-based treatment program for people with severe mental illness developed in high-income countries. We report the first randomized controlled trial of ACT in mainland China. Sixty outpatients with schizophrenia with severe functional impairments or frequent hospitalizations were randomly assigned to ACT (n = 30) or standard community treatment (n = 30). The severity of symptoms and level of social functioning were assessed at baseline and every 3 months during the 1-year study. The primary outcome was the duration of hospital readmission. Secondary outcomes included a pre-post change in symptom severity, the rates of symptom relapse and gainful employment, social and occupational functioning, and quality of life of family caregivers. Based on a modified intention-to-treat analysis, the outcomes for ACT were significantly better than those of standard community treatment. ACT patients were less likely to be readmitted [3.3% (1/30) v. 25.0% (7/28), Fisher's exact test p = 0.023], had a shorter mean readmission time [2.4 (13.3) v. 30.7 (66.9) days], were less likely to relapse [6.7% (2/30) v. 28.6% (8/28), Fisher's exact test p = 0.038], and had shorter mean time in relapse [3.5 (14.6) v. 34.4 (70.6) days]. The ACT group also had significantly longer times re-employed and greater symptomatic improvement and their caregivers experienced a greater improvement in their quality of life. Our results show that culturally adapted ACT is both feasible and effective for individuals with severe schizophrenia in urban China. Replication studies with larger samples and longer duration of follow up are warranted.

Weapons used to harm female victims of intimate partner violence and community violence

Introduction The pattern of intimate partner violence has not been studied in-depth in Sri Lanka. The aim of this study was to investigate the weapons use among women exposed to intimate partner violence (IPV) and to compare with community violence (CV). Method A retrospective, comparative cross-sectional study of women who have undergone medico-legal examination after reporting IPV or CV to a tertiary care hospital, in Colombo, Sri Lanka years from January 2011 to December 2012 was conducted. Of 9000 Medico-Legal Examination Forms, women above 18 years who had reported IPV and CV were studied. Results The prevalence of reported cases of IPV was 2.8%and CV was 5%. Of them, 255 (36%) IPV and 449 (64%) CV were reported. IPV was common among young, married, unemployed women (p 0.05). Assault with a weapon was common at home in the morning and resulted in severe injuries (p Conclusions Women exposed to IPV were young, married and unemployed. Most assaults were due to manhandling while sexual violence reports were fewer than expected. Weapon assaults are common at home in the morning and result in severe injuries but not associated with alcohol abuse. There were many similarities between IPV and CV assaults which indicate that both groups take their basis in a gender-unequal society that breeds violence. The victim knew the abuser, not only in the IPV group as expected but also in the CV group.CV occurs outside the home by known perpetrators using ‘occasional weapons’. CV in Sri Lanka and worldwide is an almost unexplored area that needs to be further investigated in order to develop evidence-based intervention programmes.

China’s New Long March to Control Illicit Substance Use: From a Punitive Regime towards Harm Reduction

Abstract Illicit substance misuse has become a serious problem in contemporary China. The number of officially registered illicit substance misusers totals close to 3 million, having increased every year since the government’s first annual report on drug control in 1998. In recent years, synthetic drugs such as methamphetamine and ketamine, have become more popular than heroin which was previously dominant. However, illicit substance use continues to receive little sympathy from the public, despite government’s efforts to move towards treatment and rehabilitation. For many years, compulsory detoxification centers and “education-through-labor” camps were the only treatment options. More humane approaches are emerging, including methadone maintenance, therapeutic communities, and faith-based halfway houses. Government response to drug trafficking remains draconian. Drug distribution and trafficking are among the dwindling number of criminal offenses that qualify for the death penalty. For future drug control policy, China appears willing to accelerate its experiment with decriminalizing substance abuse and applying a public health approach to the treatment of substance misusers. Evidence-based treatment programs through scientific research and rigorous evaluation should be the norm, and harm reduction needs to be seriously explored as an alternative to the harsh criminal justice regime. More importantly, reliable and multi-faceted forecast systems need to be established to monitor and estimate the size of substance misuser population and trends in illicit drug consumption. Finally, China should continue to expand its international collaboration and insulate its counter-narcotic programs from global politics.

Evaluation and monitoring of community youth prevention programs using a robust productivity index

Evidence-based prevention and intervention programs for youth behavioral and mental problems have been implemented by many local community program providers. Due to the differences among communities in resource availability and the demand for services, however, policymakers and program practitioners require ways of measuring organizational efficiency in terms of resource commitment and improvement in individual outcomes. In this paper, we propose a robust productivity index for monitoring managerial performance and detecting exceptions in dynamic environments. Robust productivity bounds are constructed to identify innovators who make a technical shift. The approach is illustrated with panel data on youth outcomes from a selected multi-site community prevention program between the fiscal years 2010 and 2015. The results suggest that our approach not only permits classification of the innovators, but also recognizes patterns of change in productivity.

E-Therapy in primary care mental health

The Australian Government's Fifth National Mental Health and Suicide Prevention Plan recommends a stepped care model of mental healthcare that focuses on matching the intensity of care to the severity of illness. General practitioners (GPs) need to learn more about low-intensity online interventions to better meet the needs of patients of lower severity. This article provides GPs with information about low-intensity, evidence-based online resources developed in Australia and available for integration into the care of patients with mild-to-moderate mental health conditions. This article has an emphasis on new developments since 2015. The internet provides an opportunity to deliver effective mental health treatment to people who would otherwise not seek, or be able to reach, skilled help for their mental health conditions. High-quality, evidence-based cognitive behavioural therapy treatment programs are available to all Australians, at no or low cost. These options can be integrated into a stepped care model of mental healthcare, and provide GPs with an opportunity to help patients access treatment that suits their needs.